Introducing the North American Association of Practicum Sites in Neuropsychology (NAPSN): development of a new organization devoted to facilitating high quality practicum training.

Introduction: In February 2023, a work group began to develop a new North American organization in neuropsychology to represent and support practicum-training sites. While other training-focused organizations such as the Association of Postdoctoral Programs in Clinical Neuropsychology (APPCN) and the Association of Internship Training in Clinical Neuropsychology (AITCN) have existed for many years, no organization exists to promote and support practicum level training outside of doctoral degree programs. The work group developed such an organization, subsequently named the North American Association of Practicum Sites in Neuropsychology (NAPSN), beginning with a mission statement and general purpose of the organization. Methods: The work group divided members into five task forces focused on various tasks needed to start the organization, including Mission/Vision, Administrative Structure, Membership, Financials, and Bylaws. The entire work group met monthly with additional meetings and work via email for the various task forces, which resulted in the development of a mission statement and bylaws, as well as a framework for program administration, membership requirements and financial needs. Conclusions: The group developed NAPSN primarily as a resource to support diverse practicum programs in urban, suburban, and rural areas in the US and Canada to provide optimal graduate level clinical training in neuropsychology. Didactics aimed specifically at practicum students was one need identified early in the process. NAPSN is developing a website-based resource in collaboration with other training organizations to increase the didactic offerings to practicum students. Other initiatives and collaborative efforts will be undertaken over time as circumstances warrant.

The relationship between performance validity testing, external incentives, and cognitive functioning in long COVID.

INTRODUCTION: Performance validity test (PVT) failures occur in clinical practice and at higher rates with external incentives. However, little PVT research has been applied to the Long COVID population. This study aims to address this gap. METHODS: Participants were 247 consecutive individuals with Long COVID seen for neuropsychological evaluation who completed 4 PVTs and a standardized neuropsychological battery. The sample was 84.2% White and 66% female. The mean age was 51.16 years and mean education was 14.75 years. Medical records were searched for external incentive (e.g., disability claims). Three groups were created based on PVT failures (Pass [no failures], Intermediate [1 failure], and Fail [2+ failures]). RESULTS: A total of 8.9% participants failed 2+ PVTs, 6.4% failed one PVT, and 85% passed PVTs. From the full sample, 25.1% were identified with external incentive. However, there was a significant difference between the rates of external incentives in the Fail group (54.5%) compared to the Pass (22.1%) and Intermediate (20%) groups. Further, the Fail group had lower cognitive scores and higher frequency of impaired range scores, consistent with PVT research in other populations. External incentives were uncorrelated with cognitive performance. CONCLUSIONS: Consistent with other populations, results suggest Long COVID cases are not immune to PVT failure and external incentives are associated with PVT failure. Results indicated that individuals in the Pass and Intermediate groups showed no evidence for significant cognitive deficits, but the Fail group had significantly poorer cognitive performance. Thus, PVTs should be routinely administered in Long COVID cases and research.

Use of perceptual memory as a performance validity indicator: initial validation with simulated mild traumatic brain injury.

INTRODUCTION: Many commonly employed performance validity tests (PVTs) are several decades old and vulnerable to compromise, leading to a need for novel instruments. Because implicit/non-declarative memory may be robust to brain damage, tasks that rely upon such memory may serve as an effective PVT. Using a simulation design, this experiment evaluated whether novel tasks that rely upon perceptual memory hold promise as PVTs. METHOD: Sixty healthy participants were provided instructions to simulate symptoms of mild traumatic brain injury (TBI), and they were compared to a group of 20 honest responding individuals. Simulator groups received varying levels of information concerning TBI symptoms, resulting in naïve, sophisticated, and test-coached groups. The Word Memory Test, Test of Memory Malingering, and California Verbal Learning Test-II Forced Choice Recognition Test were administered. To assess perceptual memory, selected images from the Gollin Incomplete Figures and Mooney Closure Test were presented as visual perception tasks. After brief delays, memory for the images was assessed. RESULTS: No group differences emerged on the perception trials of the Gollin and Mooney figures, but simulators remembered fewer images than the honest responders. Simulator groups differed on the standard PVTs, but they performed equivalently on the Gollin and Mooney figures, implying robustness to coaching. Relying upon a criterion of 90% specificity, the Gollin and Mooney figures achieved at least 90% sensitivity, comparing favorably to the standard PVTs. CONCLUSIONS: The Gollin and Mooney figures hold promise as novel PVTs. As perceptual memory tests, they may be relatively robust to brain damage, but future research involving clinical samples is necessary to substantiate this assertion.

Examination of the relationship between symptom and performance validity measures across referral subtypes.

INTRODUCTION: The extent to which performance validity (PVT) and symptom validity (SVT) tests measure separate constructs is unclear. Prior research using the Minnesota Multiphasic Personality Inventory (MMPI-2 & RF) suggested that PVTs and SVTs are separate but related constructs. However, the relationship between Personality Assessment Inventory (PAI) SVTs and PVTs has not been explored. This study aimed to replicate previous MMPI research using the PAI, exploring the relationship between PVTs and overreporting SVTs across three subsamples, neurodevelopmental (attention deficit-hyperactivity disorder (ADHD)/learning disorder), psychiatric, and mild traumatic brain injury (mTBI). METHODS: Participants included 561 consecutive referrals who completed the Test of Memory Malingering (TOMM) and the PAI. Three subgroups were created based on referral question. The relationship between PAI SVTs and the PVT was evaluated through multiple regression analysis. RESULTS: The results demonstrated the relationship between PAI symptom overreporting SVTs, including Negative Impression Management (NIM), Malingering Index (MAL), and Cognitive Bias Scale (CBS), and PVTs varied by referral subgroup. Specifically, overreporting on CBS but not NIM and MAL significantly predicted poorer PVT performance in the full sample and the mTBI sample. In contrast, none of the overreporting SVTs significantly predicted PVT performance in the ADHD/learning disorder sample but conversely, all SVTs predicted PVT performance in the psychiatric sample. CONCLUSIONS: The results partially replicated prior research comparing SVTs and PVTs and suggested that constructs measured by SVTs and PVTs vary depending upon population. The results support the necessity of both PVTs and SVTs in clinical neuropsychological practice.

Emotional functioning in long COVID: Comparison to post-concussion syndrome using the Personality Assessment Inventory.

Objective: Recent studies on Long COVID found that patients report prominent emotional distress and significant correlations between distress and cognitive performance have been identified, raising the question of how to manage or treat these issues. To understand psychological functioning in Long COVID further, this study examined personality responses on the Personality Assessment Inventory (PAI) to compare psychological functioning in a Long COVID group with a post-concussion syndrome (PCS) group, a syndrome with a significant psychological component. Participants and methods: Participants included 201 consecutive Long COVID outpatients (Mean age = 48.87 years, mean education = 14.82, 71.6% Female, 82.6% White) and a comparison group of 102 consecutively referred PCS outpatients (Mean age = 46.08, mean education = 14.17, 63.7% Female, 88.2% White). Effect sizes and t-tests were calculated using the PAI validity, clinical, interpersonal, and treatment consideration scales as well as clinical subscales. Results: The results replicated earlier findings on the PAI in Long COVID by demonstrating that both Long COVID and PCS groups had the highest mean elevations on SOM and DEP scales but no statistically significant between group differences in mean scale elevations. Results support similarities in psychological functioning between Long COVID and PCS patients emphasizing the importance of evaluating psychological functioning in neuropsychological evaluations for these populations. Further, results suggest that psychological treatment strategies for PCS patients may be helpful for Long COVID patients, but more research is needed.

Outcomes in post-acute sequelae of COVID-19 (PASC) at 6 months post-infection Part 1: Cognitive functioning.

OBJECTIVE: Long-term cognitive sequelae of COVID-19 have not been extensively studied. This study provides initial results on cognitive outcomes in Post-Acute Sequelae of COVID-19 (PASC).Participants and Methods: This study examined 53 consecutive outpatients diagnosed with COVID-19. Four participants were excluded due to performance validity test failure. All participants had positive COVID-19 tests, reported cognitive concerns, and completed neuropsychological tests to assess performance validity, attention/working memory, processing speed, memory, language, visual-spatial, executive functioning, motor, and emotional functioning. The sample was mostly white (89.8%), female (83.7%), and never hospitalized (69.4%) for COVID-19. RESULTS: Analyses indicated no mean scores in the Impaired range (>2 standard deviations [SD] below normative mean) on objective cognitive testing and a low base rate of Impaired test scores. Higher (>20%) base rates of Borderline performance (1-2 SDs below normative mean) were found on some measures. There was also evidence for frequently elevated mean scores on mood measures which correlated with some cognitive measures and the number of Borderline scores per participants. CONCLUSIONS: The results were noteworthy for infrequent Impaired scores, and significant correlations between cognition and mood/anxiety measures, but not between cognitive performance and premorbid vascular risk factors, psychiatric diagnoses, or COVID-19 disease severity. Results suggest that psychological distress was prominent in PASC and related to objective cognitive performance, but objective cognitive performance was unrelated to cognitive complaints. Other contributing factors may include fatigue/sleep issues. Neurologically based cognitive deficits were not suggested by the results.

Outcomes in post-acute sequelae of COVID-19 (PASC) at 6 months post-infection part 2: Psychological functioning.

Limited research investigating the long-term psychological and emotional correlates of COVID-19 infection has been completed. The current study begins to address this limitation in patients experiencing Post-Acute Sequelae SARS-CoV-2 (PASC; e.g. "Long COVID").Participants were 43 consecutive neuropsychological outpatients diagnosed with PASC and who completed the Personality Assessment Inventory (PAI). The sample was predominantly female (n = 36) and white (n = 32). Effect sizes compared to the normative mean T scores and base rates of elevated (T > 69) scores were calculated.PAI scales measuring somatic preoccupation and depression had large effect sizes and the highest base rates of scale elevations, with the mean T score at approximately the normative cutoff for clinical significance (T = 70). The Schizophrenia Thought Disorder subscale (SCZ-T) also had a large effect size and high base rate of elevation, likely reflecting cognitive concerns. Scales measuring anxiety had medium effect sizes. The other PAI scales generally had small to negligible effect sizes. There were no significant differences between hospitalized and non-hospitalized participants on the PAI.Overall, PAI scales measuring psychological distress, particularly somatic preoccupation and depression, were the most frequently elevated in the participants. The specific reasons for somatic preoccupation could not be determined in this study. Potential explanations include a vulnerability to distress in Long COVID patients, premorbid somatic preoccupation perhaps motivating these patients to seek clinical attention, or socioenvironmental factors leading some COVID patients to be somatically preoccupied with minor physiological changes and attribute those changes to COVID-19.

Validation of the Personality Assessment Inventory (PAI) scale of scales in a mixed clinical sample.

Objective: This exploratory study examined the classification accuracy of three derived scales aimed at detecting cognitive response bias in neuropsychological samples. The derived scales are composed of existing scales from the Personality Assessment Inventory (PAI). A mixed clinical sample of consecutive outpatients referred for neuropsychological assessment at a large Midwestern academic medical center was utilized. Participants and Methods: Participants included 332 patients who completed study's embedded and free-standing performance validity tests (PVTs) and the PAI. PASS and FAIL groups were created based on PVT performance to evaluate the classification accuracy of the derived scales. Three new scales, Cognitive Bias Scale of Scales 1-3, (CB-SOS1-3) were derived by combining existing scales by either summing the scales together and dividing by the total number of scales summed, or by logistically deriving a variable from the contributions of several scales. Results: All of the newly derived scales significantly differentiated between PASS and FAIL groups. All of the derived SOS scales demonstrated acceptable classification accuracy (i.e. CB-SOS1 AUC = 0.72; CB-SOS2 AUC = 0.73; CB-SOS3 AUC = 0.75). Conclusions: This exploratory study demonstrates that attending to scale-level PAI data may be a promising area of research in improving prediction of PVT failure.

Replication and cross-validation of the personality assessment inventory (PAI) cognitive bias scale (CBS) in a mixed clinical sample.

Objective: This study is a cross-validation of the Cognitive Bias Scale (CBS) from the Personality Assessment Inventory (PAI), a ten-item scale designed to assess symptom endorsement associated with performance validity test failure in neuropsychological samples. The study utilized a mixed neuropsychological sample of consecutively referred patients at a large academic medical center in the Midwest. Participants and Methods: Participants were 332 patients who completed embedded and free-standing performance validity tests (PVTs) and the PAI. Pass and fail groups were created based on PVT performance to evaluate classification accuracy of the CBS. Results: The results were generally consistent with the initial study for overall classification accuracy, sensitivity, and cut-off score. Consistent with the validation study, CBS had better classification accuracy than the original PAI validity scales and a comparable effect size to that obtained in the original validation publication; however, the Somatic Complaints scale (SOM) and the Conversion subscale (SOM-C) also demonstrated good classification accuracy. The CBS had incremental predictive ability compared to existing PAI scales. Conclusions: The results supported the CBS, but further research is needed on specific populations. Findings from this present study also suggest the relationship between conversion tendencies and PVT failure may be stronger in some geographic locations or population types (forensic versus clinical patients).

Neuropsychology trainee concerns during the COVID-19 pandemic: A 2021 follow-up survey.

OBJECTIVE: As the COVID-19 pandemic continues, the impact on neuropsychology trainees continues to evolve. This paper describes the results of a survey of neuropsychology trainee (graduate student through postdoctoral resident) perspectives on the COVID-19 pandemic and compares them to a previous survey conducted in Spring 2020. METHOD: The survey used several questions from the 2020 survey and added applicable new questions based on the results of the 2020 survey. The survey was distributed to listservs, training directors, and student organizations in neuropsychology with snowball sampling used. RESULTS: Respondents were primarily female (82.4%) and white (63%). The majority of trainees (66%) reported loss of clinical hours. Interestingly, the average training time missed was approximately 3.36 weeks (SD = 9.27). Trainees continue to report that they have experienced increased anxiety, depression, and stress since the beginning of the pandemic; however, compared to a prior survey, rates of increased anxiety/stress remained stable, but more trainees reported increased depression. Approximately 31% of trainees reported that they were differentially impacted by the pandemic due to racial/ethnic background and female trainees were more likely to report increased personal stress, anxiety and depression than their male counterparts. CONCLUSIONS: Results suggest continued wide-reaching pandemic related impacts on neuropsychology trainees. For example, trainees continue to be concerned about the impact of lost clinical hours on their professional futures. The most notable of the personal impacts included increased rates of mental health concerns and differential impacts on trainees from ethnoracial minority communities. Recommendations are provided to assist trainees in coping with pandemic-related disruptions.

Classification accuracy of the word memory test genuine memory impairment index.

OBJECTIVE: The Word Memory Test (WMT) assesses non-credible performance in neuropsychological assessment. To mitigate risk of false positives among patients with severe cognitive dysfunction, the Genuine Memory Impairment Profile was derived. Only a modest number of investigations has evaluated classification accuracy among clinical samples, leaving the GMIP's accuracy largely uncertain. Accordingly, a simulation experiment evaluated the classification accuracy of the GMIP in a group of healthy individuals coached to simulate mild traumatic brain injury (TBI) related memory impairment on the WMT. PARTICIPANTS AND METHODS: Eighty healthy individuals were randomly assigned to one of the four experimental groups. One group was provided superficial information concerning TBI symptoms (naïve simulators), another was provided extensive information concerning TBI symptoms (sophisticated simulators), and a third group was provided extensive TBI symptom information and tactics to evade detection by performance validity tests (PVT) (test-coached). An honest responding control group was directed to give their best performance. All participants were administered the California Verbal Learning Test-2 (CVLT-2) and the WMT. RESULTS: Among the TBI simulators, 90% of the test-coached, 95% of the sophisticated simulators, and 100% of the naïve simulators were correctly classified as exaggerating memory impairment on the primary WMT indices. The simulator groups performed worse than the honest responding group on the CVLT-2. Of those who exceeded the WMT cutoffs, 60%, 27%, and 6% of the naïve-, sophisticated-, and test-coached simulators manifested the GMIP profile, respectively. CONCLUSIONS: The GMIP is apt to misclassify individuals as having genuine memory impairment, especially if a naïve or unsophisticated effort is made to exert non-credible performance. Indeed, individuals who employ the least sophisticated efforts to exaggerate cognitive impairment appear most likely to manifest the GMIP. The GMIP should be used cautiously to discriminate genuine impairment from non-credible performance, especially among people with mild TBI.

Neurocognitive deficits in severe COVID-19 infection: Case series and proposed model.

Objective: To date, very few studies investigating neurocognitive deficits in COVID-19 have been published. This case series addresses cognition in post-COVID-19 patient by describing three patients in acute rehabilitation to inform a model of cognitive sequelae of COVID-19. Methods: Three English-speaking inpatients with severe symptoms and long-term intensive care unit (ICU) treatment are described. All patients had a premorbid history of hypertension and hyperlipidemia and experienced delirium and hypoxemia when hospitalized. Patient 1 is a 62-year-old male with 15 years of education with additional history of obstructive sleep apnea and type 2 diabetes. Patient 2 is a 73-year-old female with 12 years of education with a premorbid medical history of alcohol use disorder and Guillain-Barre syndrome. Patient 3 is a 75-year-old male with 14 years of education. No patients had premorbid psychiatric histories. Results: The three patients demonstrated deficits on formal neuropsychological testing, particularly with encoding and verbal fluency. Memory measures improved with a more structured story memory task compared to a less-structured verbal list-learning task, suggesting executive dysfunction impacted learning. None of the patients demonstrated rapid forgetting of information. Two patients endorsed new depressive and/or anxiety symptoms. Conclusions: The results suggest evidence for neurocognitive deficits after severe COVID-19 infection, particularly in encoding and verbal fluency. These results were interpreted with caution given the limited number of patients and the telephone-based battery. The specific mechanism that caused these cognitive deficits in these individuals remains unclear. A proposed three-stage model of cognitive dysfunction is described to help guide future research.

2020 COVID-19 American Academy of Clinical Neuropsychology (AACN) Student Affairs Committee survey of neuropsychology trainees.

Objective: To conduct an online survey in order to understand neuropsychology trainees' perspectives during the COVID-19 pandemic and identify pertinent concerns, training gaps, and recommendations.Method: A total of 874 neuropsychology trainees (81% female) completed the 69-item survey. Of the included trainees, 48% were doctoral students, 17% were interns, and 35% were postdoctoral residents (50% of resident respondents were in their first year).Results: The majority of neuropsychology trainees reported some impact of the pandemic on their professional and/or personal life. Overall, the impact did not differ by training level, geographic location, or demographic factors. Trainees' primary professional concerns included uncertainty about the impact of the pandemic on their professional future, loss of clinical hours, and desire for increased and ongoing communication from their leadership. A notable percentage of trainees reported increased personal mental health symptoms (i.e. anxiety/depression; 74%/54%), as well as a number of other personal stressors. Despite the transition to telehealth (mostly interviews/feedback sessions), few trainees have prior training or experience in providing neuropsychological services via phone or video platform. A limited proportion of trainees (approximately 10%) were still seeing patients face-to-face for neuropsychological evaluations during the COVID-19 pandemic as of 14 April 2020.Conclusions: The COVID-19 pandemic is impacting neuropsychological training and the well-being of trainees. This survey highlights the importance of communication with trainees during uncertain times. Based on the survey results, recommendations were developed to assist neuropsychology organizations in developing initiatives to support trainees during the current pandemic and in the future.

Stratified performance on the Test of Memory Malingering (TOMM) is associated with differential responding on the Personality Assessment Inventory (PAI).

Introduction: This study evaluated symptom endorsement patterns in participants at various stratified performance levels on the Test of Memory Malingering (TOMM). It was hypothesized that the lowest stratum (chance performance and below) would have the most pathological (i.e., elevated item endorsement) responding on the Personality Assessment Inventory (PAI) validity and clinical scales. This study was primarily a replication of previous work with emphasis on the PAI scales and consideration of varying degrees of performance on TOMM Trial 2.Methods: Participants were 760 (54% female, 85.4% Caucasian, mean age = 42.01 (SD = 15.89), mean education = 13.55 (SD = 2.35)) consecutively referred neuropsychological outpatients who completed the TOMM and PAI. Participants were placed in one of 5 stratified TOMM Trial 2 performance level groups (High Pass, Low Pass, High Fail, Low Fail, and Chance). No significant differences were found between the demographic variables except for referral source, which was overrepresented in the Chance group relative to the other groups.Results: Due to the highly skewed nature of TOMM Trial 2, Spearman rank order correlations were calculated for the 5 stratified levels of TOMM performance and all the main PAI scales. The NIM, SOM, DEP, ANX, SCZ and SUI scales had significant correlations, so a series of One-way ANOVAs were calculated to examine these scales at different TOMM stratified performance levels. Results indicated that the Chance group had the highest level of responding on all scales, with NIM, SOM, DEP, SCZ and SUI having mean elevations above the clinical cutoff (T = 70).Conclusions: Results were consistent with previous pass-fail PVT research, but extended earlier research to provide evidence that Chance performance group had more pathological PAI responding. The results provide preliminary evidence to support the notion that patients who fail PVTs at different levels do not have the same characteristics.

The construction and the initial validation of the Cognitive Bias Scale for the Personality Assessment Inventory.

Objective: This study describes the derivation and initial validation evidence of a novel Personality Assessment Inventory (PAI) scale designed to be sensitive to cognitive response bias, as defined by poor performance on performance validity tests (PVTs), in the context of neuropsychological assessment. The Cognitive Bias Scale (CBS) is a ten-item scale that was designed to discriminate between neuropsychological patients who passed or failed PVTs. Method: In a sample of 306 consecutive mixed neuropsychological outpatients, the CBS was derived by initially selecting items that significantly discriminated participants who passed and failed two or more PVTs, with further item refinement utilizing Item Response Theory methods. Results: Initial validation evidence suggests the CBS outperforms existing PAI symptom validity tests in predicting failure on two or more PVTs. The CBS showed good ability to discriminate between valid and invalid performance validity (Cohen's d = -0.96), with good classification accuracy (area under the curve = 0.72). Conclusions: Study results suggest the CBS may be useful in detecting cognitive response bias in a mixed neuropsychological outpatient sample; however, cross-validation will be necessary to further establish its utility.

Validity of the Verbal Concept Attainment Test in multiple sclerosis.

OBJECTIVE: As many as 70% of people with multiple sclerosis (MS) have clinically significant cognitive impairment, and most of these individuals exhibit executive dysfunction. Most research concerning executive dysfunction in MS has focused upon nonverbal measures. The Verbal Concept Attainment Test (VCAT) has demonstrated construct validity as an executive function measure in people infected with HIV and in people with focal brain lesions, but its validity among people with MS is unknown. The current study evaluated the VCAT's criterion, diagnostic, and ecological validity in people with MS. METHOD: A comprehensive neuropsychological battery was administered to 44 healthy individuals and 97 people with MS. Based on existing norms, they were classified as impaired or unimpaired, resulting in 65 people with MS categorized as unimpaired and 32 as impaired. They were administered a battery assessing neuropsychological impairment and disability status. RESULTS: The VCAT correlated with most measures of neuropsychological function, but its largest correlations occurred with measures of executive function, working memory, and verbal memory. Regarding classification accuracy, the VCAT achieved satisfactory sensitivity and specificity in identifying neuropsychological impairment in people with MS. The VCAT achieved moderate correlations with measures of disability status. CONCLUSIONS: The data provide evidence for an optimal VCAT cutoff score for establishing neuropsychological impairment in people with MS, and they demonstrate that the VCAT possesses acceptable criterion, diagnostic, and ecological validity. As such, these data support the inclusion of the VCAT in research and clinical practice involving people with MS.

Classification accuracy of individual and combined executive functioning embedded performance validity measures in mild traumatic brain injury.

The development of more sophisticated performance validity measures is important due to concerns with coaching as well as providing clinicians with a greater variety of options when assessing performance validity. Examinees with noncredible performance may find it more difficult to elude detection by PVTs derived from arithmetical summation or logistic regression. The present study evaluated the classification accuracy of several executive functioning (EF) variables as PVTs both individually and when combined into derived variables. The current study evaluated a simple mathematic summation of embedded PVT scores and a logistic regression-based formula based on embedded PVTs from executive function measures. A total of 155 consecutive patients completed neuropsychological evaluation after sustaining a mild traumatic brain injury (MTBI) were studied and were placed into a PVT-PASS (N = 95, mean age = 44.9, SD = 12.55, mean education = 13.45, SD = 2.23, 38% male, 97% Caucasian) or PVT-FAIL group (N = 60, mean age = 44.1, SD = 15.47, mean education = 13.05, SD = 2.58, 55% male, 92% Caucasian). Trail Making Test B, Wisconsin Card Sorting Test, and Stroop Color Word Test were summed and also used in logistic regression to predict whether patients had credible performance. Both the mathematical summation and the logistic regression methods achieved excellent classification accuracy (summation AUC = .79; logistic regression AUC = .82) with higher sensitivity than individual PVTs.

Long-Term Cognitive and Psychological Functioning in Post-Electroconvulsive Therapy Patients.

OBJECTIVE: Electroconvulsive therapy (ECT) is associated with positive outcomes for treatment-resistant mood disorders in the short term. However, there is limited research on long-term cognitive or psychological changes beyond 1 year after -ECT. This study evaluated long-term outcomes in cognitive functioning, psychiatric symptoms, and quality of life for individuals who had undergone ECT. METHODS: Eligible participants (N = 294) who completed a brief pre-ECT neuropsychological assessment within the last 14 years were recruited for a follow-up evaluation; a limited sample agreed to follow-up testing (n = 34). At follow-up, participants were administered cognitive measures (Repeatable Battery for the Assessment of Neuropsychological Status [RBANS], Wide Range Achievement Test-4 Word Reading, Trail Making Test, Wechsler Adult Intelligence Scale-Fourth Edition Letter Number Sequence and Digit Span, and Controlled Oral Word Association Test), along with emotional functioning measures (Beck Depression Inventory-Second Edition [BDI-II] and Beck Anxiety Inventory) and the World Health Organization Quality of Life-BREF quality of life measure. Follow-up-testing occurred on average (SD) 6.01 (3.5) years after last ECT treatment. RESULTS: At follow-up, a paired t test showed a large and robust reduction in mean BDI-II score. Scores in cognitive domains remained largely unchanged. A trend was observed for a mean reduction in RBANS visual spatial scores. Lower BDI-II scores were significantly associated with higher RBANS scores and improved quality of life. CONCLUSIONS: For some ECT patients, memory, cognitive functioning, and decreases in depressive symptoms can remain intact and stable even several years after ECT. However, the selective sampling at follow-up makes these results difficult to generalize to all post-ECT patients. Future research should examine what variables may predict stable cognitive functioning and a decline in psychiatric symptoms after ECT.